Al-Tawil Karam, Arya Anand
Queens Hospital, London, RM7 0 AG, UK.
King's College Hospital, London, SE5 9 RS, UK.
J Clin Orthop Trauma. 2021 Jul 8;20:101497. doi: 10.1016/j.jcot.2021.101497. eCollection 2021 Sep.
Radial head fractures are the commonest fractures in the elbow. They are often associated with other injuries: ligamentous, cartilaginous or other fractures. Associated injuries are important determinant of the management of the radial head fracture. These should be carefully looked for, diagnosed and treated. The original Mason classification for this fracture has been modified to include the associated injuries and their treatment. CT scan is a helpful diagnostic tool and should be used if available. Radial head fractures can be treated either conservatively or operatively (by excision, open reduction and internal fixation or prosthetic replacement). Undisplaced or minimally displaced fractures should be treated non-operatively. Internal fixation by headless cannulated screws is the preferred treatment for displaced fractures. It provides satisfactory biomechanical stability, can be done through a smaller incision, has less complications and lesser requirement of later removal of screws. Small number of fractures with comminution of neck would require plate fixation. Unfixable fractures in elderly can be treated by excision while such fractures in younger population or associated with significant soft tissue or bony injuries would require prosthetic replacement.
桡骨头骨折是肘部最常见的骨折。它们常与其他损伤相关：韧带、软骨或其他骨折。相关损伤是桡骨头骨折治疗的重要决定因素。应仔细查找、诊断和治疗这些损伤。该骨折最初的梅森分类已被修改，以纳入相关损伤及其治疗方法。CT扫描是一种有用的诊断工具，如有条件应使用。桡骨头骨折可采用保守治疗或手术治疗（通过切除、切开复位内固定或假体置换）。无移位或轻度移位的骨折应采用非手术治疗。无头空心螺钉内固定是移位骨折的首选治疗方法。它提供令人满意的生物力学稳定性，可通过较小的切口完成，并发症较少，后期取出螺钉的需求也较少。少数伴有颈部粉碎的骨折需要钢板固定。老年患者无法固定的骨折可通过切除治疗，而年轻患者的此类骨折或伴有严重软组织或骨损伤的骨折则需要假体置换。
